Integrated Management of Childhood Illnesses IMCI Dr Pushpa
- Slides: 29
Integrated Management of Childhood Illnesses (IMCI) Dr. Pushpa Raj Sharma DCH, DTCH, FCPS Professor of Child Health Institute of Medicine, Kathmandu, Nepal
Burden of the Paediatric Disease in Nepal ® 40, 000 deaths are pneumonia related. ® 30, 000 deaths are diarrhea related ® 40, 000 deaths are nutrition related ® 50% deaths are related with neonatal problems.
Burden of these diseases are due to: ® Unskilled health worker ® Bad family health practices ® Unequipped health facility ® Unavailability of health resources
Problems in different age groups: ® Neonatal period: resuscitation problems, infections, metabolic. ® Under five: infections, nutritional. ® Preadolescent: developmental, worms, skin. ® Adolescent: psychological, sexual habits, drugs.
Common causes of morbidity and mortality ® Morbidity Acute respiratory infections. ® Diarrhea ® Fever ® Ear infections ® Malnutrition ® Local skin infections ® Oral thrush ® ® Mortality Pneumonia ® Severe dehydration ® Meningitis/encephalitis ® Cerebral malaria ® Kwashiorkor/marasmus ® Sepsis ® Hypothermia ® Hypoglycemia ®
Previous programmes ® Training of health workers ® Vertical programmes ® Child problems were seen as a separate issues ® Very little counseling training ® Little emphasis on clinical practice
What is needed? ® National goal for reducing the morbidity and mortality. ® Holistic approach. ® Improving family practices. ® Equipping the health facility. ® Upgrading the health workers skills. ® Emphasis on counseling.
How to do it? ® Targeting the problem. ® All the components in one part. ® Optimal use of resources. ® Evidence based. ® Feasible. ® Acceptable by community.
Sensitivity and specificity 100% Sensitivity Specificity Clinical signs Investigations Sensitivity: positive with diseas Specificity: negative without dis
The answer ® Integrated ® Management ® Childhood ® Illnesses ®IMCI of
How it helps? ® Identifies a child who needs urgent referral. ® Gives evidenced based clinical signs for the diagnosis of common problems. ® Provides guidelines for the appropriate treatment. ® Educates the parent. ® Upgrades the health care facility. ® Follow-ups the child.
Conditions that it covers ® Respiratory: pneumonia, cough/cold. ® Diarrhea: acute watery, dysentery, persistent. ® Fever: malaria, measles, meningitis, encephalitis. ® Ear problems: mastoditis, acute and chronic infections. ® Nutritional: kwashiorkor/marasmus, anemia
Conditions that it covers ® Nutritional: feeding problems, breast feeding, counseling. ® Neonatal sepsis. ® Local infections. ® Hypoglycemia, hypothermia. ® Oral thrush ® Immunization. ® Vit. A supplementation ® Deworming.
What it contains? 2 months up to 5 years ® Simple clinical signs of severe disease. ® Simple clinical signs to diagnose pneumonia. ® Simple clinical signs to identify three clinical types of diarrhea. ® Simple clinical signs to identify malaria. ® Simple clinical signs to identify ear infections. ® Simple clinical signs to identify malnutrition.
What it contains? Young infant. ® Simple clinical signs to identify for referral. ® Simple clinical signs to treat at health facility. ® Simple signs to identify good breast feeding.
What it contains? General ® Simple guidelines for nutrition. ® Simple guidelines for treatment of severe diseases, pneumonia, diarrhoea, dysentery, fever, malaria, ear infections, local infections, anaemia, malnutrition. ® Guidelines for counseling. ® Home care messages, safe practices. ® Immunization, vit A, deworming information.
What are the evidences? ® Trained health worker identified target disease better than doctors. ® Over prescriptions were reduced. ® Parents were more satisfied. ® Cost effective. ® Mortality and morbidity reduced. ® Health facility better equipped.
Some examples ® Simple questions and simple observations to find out the problem: severe disease. ® Does child vomits every thing? ® Is the child able to drink? ® History of convulsions? ® Is the child lethargic or unconscious?
Four main symptoms: 2 months up to 5 years ® Does the child has cough or difficulty breathing? ® Does the child has diarrhea? ® Does the child has fever? ® Does the child has ear problem?
Assess every child for: 2 months up to 5 years ® Malnutrition: ® Weight for age ® Oedema ® anaemia ® Immunization ® Vitamin A supplementation ® Deworming
If the answer is yes: ® For how long? ® Associated symptoms? ® Classify the illness ® Identify treatment ® Treat the child
My child has cough for 2 days: (example) ® Observe for general danger signs. ® If present refer the child with first dose of antibiotics. ® Count the respiratory rate: 60/50/40. ® Fast breathing indicates pneumonia. ® Look for indrawing. ® If present indicates severe pneumonia and needs referral. ® Look and listen for stridor in a calm child. ® If present indicates severe disease and referral is needed.
Classify the disease (example) ® Age 9 months: no general danger signs, no chest indrawing, no stridor, no fast breathing. ® No pneumonia (cough and cold). ® Age 12 months: chest ® Severe pneumonia. ® Age 4 months: ® Pneumonia. indrawing. fast breathing only. ® Age 6 months: presence of general danger sign. ® A child with very severe disease.
Identify treatment (example) ® No ® pneumonia: Safe home remedies/ paracetamol/ when to return? Counsel. ® Pneumonia: ® Antibiotic/paracetamol/safe home remedies/when to return? Counsel. ® Severe ® pneumonia/very severe disease: First dose of antibiotic/ referral note/ counsel.
Treat the child ® Essential drugs. ® Safe home care. ® Duration of treatment. ® When to return. ® Change of treatment. ® Counsel the parent. ® Other problems.
Other Options in IMCI ® Neonatal problems of first week ® Developmental pediatrics ® Perinatal problems ® Injury ® ……….
IMCI : model for other problems in pediatric diseases ® Entry questions. ® Threading questions. ® Evidenced based specific clinical signs. ® Treatment. ® Follow-up. ® Referral. ® Counsel.
History of IMCI in Nepal ® 1995: IMCI Activities started. District identified, Saptari. ® 1996: Orientation meeting, nutrition survey, necessary adaptations to generic materials. ® 1997: Nepali translation, TOT courses. ® 1998: Follow-up visits, review meeting, preservice training. ® Expansion: at present 13 district.
Thank you. Any questions? Any clarifications? Any suggestions for this presentation?
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